Health care advocates in Maine lambasted the House replacement to the Affordable Care Act on Thursday, saying that if it becomes law it would drive up insurance costs, cause many people to lose coverage and create turmoil in the nation’s health care system.

The American Health Care Act, if it were to pass the Senate, is widely expected to result in skyrocketing premiums for those who are older and live in rural parts of the country. That could affect many Maine residents.

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Emily Brostek, executive director of Augusta-based Consumers for Affordable Health Care, a health advocacy group, said many consumer protections will be under threat if the American Health Care Act becomes law.

“What this has done is create chaos in the health care system and in the insurance markets,” Brostek said. “If this version passes, tens of thousands of Maine people will lose their coverage.”

The vote hinged on lawmakers such as Rep. Bruce Poliquin of Maine, R-2nd District, who had not revealed how he would vote until he announced his support about an hour before the vote. Poliquin helped provide the narrow margin to approve the American Health Care Act, which would slash funding that helps people pay their insurance premiums on the individual marketplace, end Medicaid expansion and cut Medicaid, while cutting taxes for the wealthy.

Emily Brostek, executive director of Consumers for Affordable Health Care, helps a client enroll in the Affordable Care Act insurance exchange in 2013. Brostek said Thursday that if the House Republican health care plan becomes law, “tens of thousands of Maine people will lose their coverage.” Kennebec Journal photo by Andy Molloy

Poliquin attacked the Affordable Care Act, also known as Obamacare, for causing premium increases and being unsustainable.

However, about 20 million Americans have insurance through the Affordable Care Act, and the nation’s uninsured rate has declined from about 18 percent in 2013, before many provisions of the ACA went into effect, to 10.9 percent in 2016. About 80,000 Mainers have health insurance through the ACA.

Under the House bill, older Mainers in rural areas could see their premiums increase up to seven times what they’re currently paying under Obamacare, going from about $200 to $300 per month to about $1,300 per month, according to the Kaiser Family Foundation.

Health experts said the American Health Care Act would make health coverage worse on many fronts, including undermining ACA protections for patients with pre-existing conditions and weakening requirements that certain health benefits be covered, such as therapy for mental illness and substance use disorders.

‘TOOK A BAD THING … MADE IT WORSE’

The American Health Care Act hasn’t undergone an analysis by the Congressional Budget Office, but a similar bill that failed to get a House vote in March was estimated to cause 24 million Americans to lose health care coverage.

Steven Michaud, president of the Maine Hospital Association, said the House bill threatens an “already fragile safety net” in rural Maine, where hospitals are closing departments and scaling back services.

“What’s bad for rural Maine is bad for rural hospitals,” Michaud said. “Our view is they took a bad thing (the previous House Republican bill) and made it worse. We’re probably even more opposed to it now.”

The bill now goes to the Senate, where it faces an uncertain future. Sen. Susan Collins, R-Maine, a key moderate in the closely divided body, opposed the previous version of the bill, and the AHCA bill approved on Thursday is further to the political right.

Collins and Sen. Bill Cassidy, R-Louisiana, proposed an ACA replacement bill this winter that was much closer to the political center, but has so far not gained any traction, although several national media outlets were reporting an increased focus on Cassidy-Collins after Thursday’s vote.

Collins said Thursday that the House bill raises several key questions for her, including the treatment of pre-existing conditions; how costs compare to ACA costs – especially for low-income elderly residents in rural areas; how Medicaid changes would affect vital services for special education students and Maine individuals, families and health care providers; and the overall effect on Maine people, especially those who rely on the ACA for coverage.

“Although I will carefully review the legislation the House passed today,” Collins said in a statement, “at this point, there seem to be more questions than answers about its consequences.”

She pointed out that ACA insurance markets are in danger of collapse in some states and said Congress needs to take the time necessary “to get this right and work to achieve the goal of expanding access to health care that is truly affordable and accessible.”

KING: AHCA ‘IS A DISASTER FOR MAINE’

Sen. Angus King of Maine, an independent who caucuses with Democrats, said that if the House bill were to become law, it would hit rural Maine especially hard, with rural hospitals harmed financially and skyrocketing premiums for rural Mainers.

“This is a disaster for Maine and the country,” King said. “Many of our rural hospitals are already running in the red.”

King said in Maine, the money coming to the state from the federal government to help make insurance affordable would decline from $350 million under the ACA to $80 million under the House replacement plan. That would result in many losing health care coverage, not only among people who receive ACA insurance, but also among the more than 260,000 Mainers who receive insurance through Medicaid, which would be cut under the bill.

King said the House voted for the AHCA without a Congressional Budget Office analysis, an indication that House Republicans knew the review would potentially be worse than the previous version of the bill.

“This was like jumping off a cliff without knowing that there was something soft at the bottom,” he said.

Rep. Chellie Pingree, D-1st District, said the vote was “driven by politics” because President Trump “wanted funds out of the ACA to spend on tax cuts.”

“Everything about this bill is bad,” she said.

RISK OVER PRE-EXISTING CONDITIONS

The American Health Care Act would allow states to opt out of protections for people with pre-existing conditions, permitting insurance companies to charge more for those with conditions like cancer, asthma, arthritis, chronic obstructive pulmonary disorder, diabetes and other diseases or conditions.

The Center for American Progress, a Washington-based left-leaning think tank, estimated that annual premium surcharges under the AHCA would be about $4,000 for asthma, $140,000 for cancer and $26,000 for rheumatoid arthritis.

“The protections for pre-existing conditions are really important,” said Dr. Dora Anne Mills, vice president of clinical affairs at the University of New England. “Who among us is not going to have a serious illness and have a pre-existing condition by the time we’re 35 or 40?”

Nicole Clegg, vice president of public policy for Planned Parenthood of Northern New England, said the United States would go back to the days when pregnancy or sexual assault could be considered a pre-existing condition.

Insurance companies could charge a pregnant woman about $17,000 per year premium surcharge, according to the Center for American Progress.

“It’s punitive for women. It’s discrimination based on the fact that women get pregnant,” Clegg said. “The idea that sexual assault could be considered a pre-existing condition is offensive.”

The AHCA also would bar Medicaid from reimbursing Planned Parenthood for medical services provided to Medicaid patients. Planned Parenthood does not receive any federal money for abortions, but does get funds for providing other reproductive health services or care to women.

Clegg said since 25 percent of Planned Parenthood’s roughly 10,000 patients in Maine are Medicaid recipients, the loss of funding would threaten the closure of one or more locations. Planned Parenthood has clinics in Portland, Topsham, Sanford and Biddeford.

Brostek said perhaps the Cassidy-Collins bill will get new life, because the AHCA is such a poorly conceived bill.

“It’s up to the Senate now to get this right,” Brostek said. “The Cassidy-Collins bill is the only one that made any attempt at bipartisanship, and to get Democrats and moderates at the table.”

King said anything is possible, and he wouldn’t assume that the Senate is going to kill the House bill.

“I’m worried what’s going to happen in the Senate, that senators will want to check the box so they can say they repealed Obamacare,” King said.

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